Saturday, 11 February 2017

Warning: Photos Featuring Extreme Bloodshed and Violence

Before I begin: do not
read this article! There is much bloodshed and violence to living tissues
herein! Horror and manglement!

This is your last
warning!!!!!1!!!!!!

OK, so you decided to
read further? On your own head be it. Don’t say I didn’t warn you.

One of my colleagues referred
a 33 year old male specimen to me. Said specimen had had pain and swelling in
the back of the upper right jaw and great difficulty in opening his mouth, a
condition that suggested an impacted, that is, crooked and partially erupted,
wisdom tooth. Sure enough, after his pain, swelling, and jaw stiffness had been
cured with antibiotics and muscle relaxants, the X Ray I took showed an
impacted upper third molar, which you can see here, arrowed for your convenience.

The only solution for
the problem was to remove the tooth, which is very easy to say but not so easy
to do. Here’s why.

Note that the tooth is
pointing forwards at an angle. This is known as a mesioangular impaction.It is very common in lower wisdom teeth, but
rather rare in uppers. Apart from the rarity, there was no space to spare
between the front of the tooth and the back of the tooth in front, which meant
that I couldn’t stick an instrument between them and lever the tooth downwards.

That, actually, was
just the start of my difficulties.

Here is what I saw
when I checked the tooth in the jaw. In this photo, you can see that only a
tiny part (the tip of one edge of the crown, as it happens) of the tooth is
visible. Like many of the following images, this one was photographed in
reflection in my mirror.

For greater clarity, I’ve marked the tooth in the photo with a black circle and arrow.

Here, in the X Ray, is
what I could actually see of the tooth:

Obviously, the vast
majority of the tooth being buried in the jawbone, I’d have to expose it and
remove enough bone around it to be able to take it out. Here, I am cutting a
flap in the gum using a No 15 Bard Parker Knife blade:

After that, I used a
tungsten carbide bur mounted in an airotor surgical straight handpiece to drill
away bone on both sides of the tooth, as you can see in the photo below. After
that, I attempted to loosen it in its socket but was unable to do so; there was
still far too much bone around it. Accordingly, I decided to cut a groove in
the tooth itself and use it as a lodgement point for an instrument called an
elevator.

With an elevator in
the groove I’d cut in the tooth, I drew it down and out. Here’s the tooth.

I’ve marked the
groove I cut with a black circle.

Now, though the tooth
was out, there was a large open wound in the gum around the socket, which I’d
have to close:

It took two black silk
sutures to close the wound, but it was very successfully closed, as you can
see.

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